rapid nutrition assessment (rna) report · 13th to 19th january, 2016 ... acf is a...

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Rapid Nutrition Assessment (RNA) Report

Kabul Informal Settlements (KIS), Kabul Province

Afghanistan

13

th to 19

th January, 2016

Funded by:

Reported by: Dr. Baidar Bakht Habib

ACF is a non-governmental, non-political and non-religious organization

AFG

HAN

ISTAN

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Acknowledgement

ACF would like to thank from the following stakeholders for their support during the implementation of Rapid Nutrition Assessment (RNA) in Kabul Informal Settlements (KIS):

The Ministry of Public Health especially the Public Nutrition Department (PND).

All the community members in Kabul informal Settlements for allowing and availing their time throughout the assessment period

Common Humanitarian Fund (UNOCHA-CHF) for their financial support and provision of updated geographical and population lists

UNICEF and WFP for providing measuring equipment.

ACF staff based in Kabul, Mazar and Paris who engaged in the successful implementation of KIS.

All the survey teams for the fully participating during training and data collection process

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Abbreviations

ACF Action Contre la Faim ARI Acute Respiratory Infections BHC Basic Health Center CHF Common Humanitarian Fund CHW Community Health Worker DK Don’t Know ENA Emergency Nutrition Assessment EPI Extended Program for Immunization GAM Global Acute Malnutrition HAZ Height-for-Age in Z-scores HF Health Facility HH Household IDP Internally displaced persons KIS Kabul informal Settlements MAM Moderate Acute Malnutrition MUAC Mid-Upper Arm Circumference OTP Out-patient Therapeutic Programme PD Provincial District PPS Probability Proportion to Size RNA Rapid Nutrition Assessment SAM Severe Acute Malnutrition SD Standard Deviation SFP Supplementary Feeding Programme SMART Standardized Monitoring and Assessment of Relief and

Transitions U5 Under-Five UNICEF United Nation Children’s Fund UNOCHA United Nation Office for the Coordination of Humanitarian

Affaires WAZ Weight-for-Age in Z-scores WFP World Food Program WHO World Health Organization WHZ Weight-for-Height in Z-scores

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Table of Contents

ACKNOWLEDGEMENT ---------------------------------------------------------------------------------------- 2 ABBREVIATIONS ---------------------------------------------------------------------------------------------- 3 LIST OF TABLES ---------------------------------------------------------------------------------------------- 4 EXECUTIVE SUMMARY --------------------------------------------------------------------------------------- 6 INTRODUCTION ----------------------------------------------------------------------------------------------- 7 SURVEY OBJECTIVES----------------------------------------------------------------------------------------- 7 BROAD OBJECTIVE ------------------------------------------------------------------------------------------------ 7 SPECIFIC OBJECTIVES --------------------------------------------------------------------------------------------- 8 METHODOLOGY ----------------------------------------------------------------------------------------------- 8 SAMPLE SIZE, SAMPLING DESIGN AND PROCEDURES ---------------------------------------------------------------- 8

Sample size and sampling design --------------------------------------------------------------------- 8 Sampling procedures ----------------------------------------------------------------------------------- 8

DATA COLLECTION ------------------------------------------------------------------------------------------------ 9 Anthropometric data (6-59 months age) ------------------------------------------------------------ 9 Measles immunization status (among aged 9-59 months) --------------------------------------- 10 Morbidity data (among aged 0-59 months) -------------------------------------------------------- 10

FINAL SAMPLING STRATEGY -------------------------------------------------------------------------------------- 10 TRAINING AND SUPERVISION ------------------------------------------------------------------------------------- 10 RESULTS ------------------------------------------------------------------------------------------------------11 ANTHROPOMETRIC RESULTS ------------------------------------------------------------------------------------- 11 CHILD HEALTH AND IMMUNIZATION ------------------------------------------------------------------------------ 13 MATERNAL NUTRITIONAL STATUS -------------------------------------------------------------------------------- 14 DISCUSSION NOTE -------------------------------------------------------------------------------------------14 DATA QUALITY AND RELIABILITY OF THE RESULTS ---------------------------------------------------------------- 14 UNDERNUTRITION RATES ----------------------------------------------------------------------------------------- 14 SUMMARY OF RECOMMENDATIONS -----------------------------------------------------------------------15 NUTRITION ------------------------------------------------------------------------------------------------------ 15 CHILD HEALTH STATUS------------------------------------------------------------------------------------------- 15 ANNEXES ------------------------------------------------------------------------------------------------------16 ANNEX 1: SELECTED CLUSTER/VILLAGES FOR DATA COLLECTION, KIS RNA, JANUARY 2016 --------------------- 16 ANNEX 2: PLAUSIBILITY CHECK FOR DATA QUALITY: KIS _ KABUL_ RNA _ 2016_JAN.AS ---------------------- 17 ANNEX 3: KABUL INFORMAL SETTLEMENTS (KIS) MAP ------------------------------------------------------------ 29 ANNEX 4: RNA QUESTIONNAIRE --------------------------------------------------------------------------------- 30 ANNEX 5: RNA TALLY SHEET ------------------------------------------------------------------------------------ 31

List of tables Table 1: Expected precision (%) based on GAM prevalence ................................... 8

Table 2: Final sampling strategy ................................................................ 10

Table 3: Case definition based on MUAC ....................................................... 11

Table 4: Distribution of age and sex of sample ............................................... 11

Table 5: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex ............................................................................... 12

Table 6: Distribution of acute malnutrition and oedema based on weight-for-height z-scores ................................................................................................ 12

Table 7: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex ................................................................................................ 12

Table 8: Prevalence of underweight based on weight-for-age z-scores and by sex...... 12

Table 9: Prevalence of stunting based on height-for-age z-scores and by sex ........... 13

Table 10: Mean z-scores, design effect and excluded subjects ............................. 13

Table 11: Under-five morbidity, two week recall, n=407 .................................... 13

Table 12: Measles immunization status, children 9-59 mounts, n=355 .................... 13

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Table 13: Physiological status of women of reproductive age (15-49 years), n=249..... 14

Table 14: Maternal nutritional status based on MUAC cut off, n=249 ...................... 14

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Executive Summary

The Rapid Nutrition Assessment was conducted in Kabul Informal Settlements (KIS) on 13th to 19th January 2016. A total of 407 children 0 to 59 months were assessed, with 216 households covered. The RNA report provides an analysis and interpretation of nutrition anthropometric, child morbidity and measles immunization among children 0-59 months (below).

Summary of key anthropometric findings:

375 children from 6-59 months of age assessed

GAM prevalence by WHZ <-2 z-scores and/or MUAC<125 mm and/or the presence of bilateral oedema is 21,9% (95% CI 17,7 -26,1) and SAM is 5,9% (95% CI 3,5-8,2)

GAM prevalence by WHZ<-2 and/or the presence of bilateral oedema was at

12.0% (9.0-15.7 95% CI) and SAM is 1.9% (0.9- 4.2 95% CI).

GAM prevalence by MUAC<125 mm and/or the presence of bilateral oedema

was at 14.9% (9.8-22.0 95% CI) and SAM is 2.4% (1.1- 5.5 95% CI).

No oedema cases were identified

Prevalence of stunting was at 51.1% (44.9-57.3 95% CI) while severe stunting

was at 22.5% (17.3-28.7 95% CI).

Total underweight was at 32.6% (26.5-39.4 95% CI) and severe underweight was

12.3% (8.0-18.5 95% CI).

Summary findings have excluded extreme values (SMART Flags— +/- 3SD from the

observed mean).

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Introduction

Since 2001, Kabul city population has significantly been increasing due to returnees of different origin: former immigrants, returnees and internally displaced people coming from rural and insecure zones of Afghanistan. The one who can afford it, purchase land to build houses, but the majority, settle in empty public or private spaces illegally. Thus, Kabul Informal Settlements were created and exist since more than 14 years. The settlers are in a constant movement, people come and go, and some of the settlements get forcibly moved or destroyed. Usually people leaving the settlement just move and squat in another area or join another settlement.

As of January 2016 humanitarian actors have identified 48 Kabul informal Settlements (KIS) with an estimated 7,889 families and 45,695 individuals1. This population is a mix of mainly conflict-induced IDPs, returnees from abroad in secondary displacement, flood and drought victims and among the forced displaced some economic migrants seemingly unaffected by conflict of disaster following the urbanization trend in hope of better livelihoods.

The populations settle mainly following an ethnic principle (Pashtun, Tajik, Jogi, Pashayee, Parachi etc.). They mainly settle close to markets where job opportunities can be found. An acute shortage of affordable housing forces people to build insecure muddy shelters. A part of the settlers are living under tents or in old destroyed building with risks of roof collapsing. There are no public services and infrastructures in the settlements. The high density of households and the proximity lead to unhealthy conditions of life, with a crucial lack of sanitary infrastructures. In many cases, families keep their animals between the tents. A lot of the women are prone to beggary using their emaciated children.

As the land is either occupied illegally or “unplanned” for construction, according Kabul City Master Plan Area, provision of any durable service or infrastructure is not possible. The most recent food security assessment conducted in the KIS indicates that there is high food insecurity. Food insecurity based on the food consumption score and food-based coping strategies is estimated at 80% (6,314 households) of the total 7,982 IDP households. Among them, an estimated 3,788 households (or 48%) are severely food insecure, and another 2,525 households (32%) are moderately food insecure2. In consequence it is also indicated that there is a likelihood that the most vulnerable members of this community (children <5years and pregnant and lactating women) may be at risk of malnutrition as a result of lack of food, poor sanitation and hygiene situation in these settlements.

It is in this regard that ACF proposed to conduct a Rapid Nutrition Assessment to better understand the nutrition situation on these vulnerable groups in these settlements and provide appropriate recommendations and actions to the cluster and other stakeholders. This assessment provides evidence based statistics on the current nutrition situation in the KIS. It is expected that the results of the assessment will be useful in designing proper nutrition interventions for the KIS.

Survey Objectives

Broad objective To evaluate the nutritional status of under-fives and need for emergency

nutrition programming

1 KIS Population data –Updated 4/01/2016- UN-OCHA 2 Kabul Informal Settlement (KIS) Winter Needs Assessment-November 2015

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Specific objectives To estimate Global Acute Malnutrition (GAM) rates among children from 6 to 59

months living in KIS

To estimate two weeks recall morbidity among children from 0 to 59 months living in KIS

To estimate measles vaccination coverage among children from 9 to 59 months living in KIS

Methodology

Sample size, sampling design and procedures

Sample size and sampling design

The population assessed included inhabitants of more than one settlement. In this case, the minimum required sample to get rapid but reliable estimations of under nutrition was fixed at 200 children from 6-59 months old. They were selected using two-stage cluster sampling. The number of clusters was also fixed to a minimum of 25.

The table below presents the precision which was expected to be reached, according to the GAM result.

Table 1: Expected precision (%) based on GAM prevalence

Expected GAM Prevalence Minimum Sample size Precision

20% 200 children +/- 7.1%

15% 200 children +/- 6.3%

10% 200 children +/- 5.3%

5% 200 children +/- 3.9%

To reach the required number of sample size, the RNA design for Afghanistan proposes simplified rule to convert children into households:

A. When the percentage of children under age of 5 is below 15%, 25 clusters of 12 households have to be selected

B. When the percentage of children under age of 5 is above 15%, 25 clusters of 10 households have to be selected

The reference percentage of under-five population for Afghanistan is 15.6%3. In this case, option B was applied. 25 clusters were selected randomly using PPS by ENA software out of the

total list identified above, while 10 households in each of clusters were selected. The cluster definition in KIS refers to smallest unit defined as settlement unit. According to latest reports from UNOCHA there are 48 settlements in KIS.

Sampling procedures

Households Simple random sampling method was used where an up-to-date list of the households in each settlement was available. All houses were enumerated and given numbers by the survey team. The 10 households were then chosen at random from the total list of households. The survey team participated in random picking of listed households from a hat every morning, while at

3 Afghanistan Mortality Survey, 2010

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the field, in each of randomly selected clusters. In cases where it was difficult to obtain an updated list of households, a systematic random sampling was used to identify the households to be surveyed. The teams were trained on both methods of sampling (simple and systematic random sampling) and they were also offered with materials to assist in determining the households during the data collection exercise. In cases where there were large settlements in one cluster (more than 150 households), the settlement was divided into smaller segments. One segment was selected randomly to include the cluster. This division was done based on existing land marks in the settlement e.g. natural borders, masjid, schools, river, mountains, street and road. It’s important to note, for the sake of simplification and rapidity, polygamous families were accounted as ONE household. In each selected settlement, one or more community member(s) was asked to help the survey teams to conduct their work by providing information about the settlement, its geographical organization or the number of households. Children All children from 0 to 59 months of age living in selected households were included in the cluster. Careful age identification by use of locally developed event calendar, child dental chart, was adopted. Local event calendar were updated and elaborated with the staffs during the training using the official calendar in Afghanistan, the solar Hijri calendar (Iranian calendar). Women All eligible women residing in the sampled households aged between (15-49 years) were assessed for their nutritional status. The following information was collected: Mid Upper Arm Circumference (MUAC), physiological status, age. Their nutritional status was evaluated using the cut-off of 230 mm.

Data collection A simple tally sheets instead of a questionnaire was used (Annex 4 and Annex 5). Surveyors would simply write down these data for each child. The number of the child in the household and the number of the household in the cluster was also recorded.

Anthropometric data (6-59 months age) The sex: was recorded with codes: F = female and M = male. The age: was written down in months. Weight (in kg): children were weighed to the nearest 0.1 kg by using an electronic uniscale (or SECA). The children who could easily stand were asked to stand on the weighing scale and their weight recorded. In a situation when the children could not stand up, the double weighing method was applied4. Height (in cm): Measuring board was used to measure bare headed and barefoot children. The precision of the measurement was 1 mm. Children of less than 87 cm were measured lying down and those equal to or above 87 cm were measured standing up. All children were also checked for oedema. If a child was suspected to have nutritional oedema then both enumerator MUST confirm this. It was essential that all staff be well trained to check for oedema. MUAC: The MUAC measurement was recorded in millimetres. MUAC must only be taken on the LEFT arm using MUAC tape. Once measured, visible small mark on the left upper arm or on the fingernails of the child were made in order to avoid measuring the same child several times. Bilateral pitting Oedema: recorded as “yes” or “no”

All children detected as SAM whether by presence of bilateral pitting oedema and/or weight-

4 The first measurement is the weight of the care taker and the second is the weight of the caretaker with the child.

The scale can record the first measurement and automatically extract it from the second measurement, showing only the weight of the child on the screen.

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for-height <-3 z-score and/or MUAC < 115 cm, were referred to the nearest facility or agency responsible for therapeutic care for immediate treatment.

Measles immunization status (among aged 9-59 months) For all children selected in the sample, the mother/caretaker (CT) was asked if the child has been immunized against measles or not, and if there is a vaccination card. The answers are recorded as ‘Y’ (Yes); ‘VWC’ (Vaccination without Card); ‘N’ (No); ‘DK’ (Does not Know), according to the situation.

Morbidity data (among aged 0-59 months)

All children selected in the sample, the mother or Care-taker (CT) was asked: If the child had diarrhea within the last 14 days. Diarrhoea is defined as every episode of more than 3 liquid stools per day. Record was made as follows: ‘Y’ (Yes); ‘N’ (No) and ‘DK’ (Does not Know). Mother or caretaker was also asked if the child had Acute Respiratory Infection (ARI) within the last 14 days. Acute Respiratory Infection is any episode with severe, persistent cough or difficulty breathing. Record was made as follows: ‘Y’ (Yes); ‘N’ (No); ‘DK’ (Don’t Know), according to the situation.

Final Sampling Strategy

25 of Clusters Clusters were based mainly on settlements (cluster selection is in Annex 1)

0 of Reserve Clusters used

Table 2: Final sampling strategy

The survey attained 375 children as highlighted in table 2. A total of 204 households were surveyed representing 81.6% of actual number of households planned for the survey, based on the fact that the survey random selected 25 clusters in which the team had to cover 10 households from each. It is important to note that the minimum required sample size in RNA is children which the survey managed to reach and exceed. No clusters were missed during the survey however due to the high number of absent HH in the survey the number of HH reached was lower than the number of HH planned initially.

Training and supervision The survey data collection team was composed of eight teams of two members each. Each team was composed of one team leader and one data collector. The previous experience from Afghanistan has shown that in some cases people are not eager to allow surveyors to measure female children. It was important to bear that in mind while conducting RNA and to have as much as possible mixed teams of surveyors that have adapted communication approach. The two teams will have one supervisor in the field together with teams and all teams were supervised by ACF Nut-SMART Senior Program Manager. The teams received 3 days training on data collection and measurement and one day standardization test.

Number of HH

planned

Number of HH

surveyed

% surveyed /planned

Number of children 6-59

months planned

Number of children 6-59

months surveyed

% surveyed /planned

250HHs 204HHs 81.6% 200 children 375 187.5%

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One field guidelines document with instructions and household definition and selection document was provided to each team member. All documents, such as local event calendar, questionnaires or consent forms were translated in Dari and Pashto, local language, for better understanding and to avoid direct translation during the data field collection. The questionnaires were back translated using a different translator. Alterations were made as necessary. Daily data entry and analysis was done using ENA plausibility check, and feedback was provided to the data collection teams. Anthropometric data was directly entered into ENA.

Results

The anthropometric data was analysed using ENA for SMART software 2011 (update 9th July 2015). Survey results are presented in reference to WHO standards for overall final analysis.

Data quality check was done using ENA for SMART software. The software was also used to generate a survey report automatically. If all anthropometric measurements were collected, then ENA will generate results for acute malnutrition (WHZ and MUAC separately), stunting (HAZ), and underweight (WAZ)5. Results are presented in (%) z-scores with 95% Confidence Interval.

These are defined as follows in Table 3 and 4.

Table 3: Case definition based on MUAC

Classification Normal Moderate Acute Malnutrition Severe acute malnutrition

MUAC

= or > 125mm = or > 115 and < 125mm

< 115mm and/or oedema

Table 4: Case definition based on weight for height z-scores

Acute Malnutrition Underweight Stunting

Global WHZ <-2 z scores and/or oedema

WAZ <-2 z scores HAZ <-2 z scores

Moderate -3 < WHZ < -2 z scores

-3 < WAZ < -2 -3 < HAZ < -2 z scores

Severe WHZ < -3 z scores and/or oedema

WAZ < -3 z scores HAZ < -3 z scores

Anthropometric Results

The results are presented with exclusion of z- score from observed mean SMART flags: WHZ -3 to + 3, HAZ -3 to +3 and WHZ -3 to +3.the overall data quality check is shown in Annex 2.

Age ratio was of 0,9 and sex ratio was 0,85 (refer to plausibility check in Annex 2).

Table 4: Distribution of age and sex of sample

Boys Girls Total Ratio

AGE (mo) no. % no. % no. % Boy: girl

6-17 28 36.4 49 63.6 77 20.5 0.6

18-29 42 44.2 53 55.8 95 25.3 0.8

30-41 45 45.5 54 54.5 99 26.4 0.8

42-53 40 58.8 28 41.2 68 18.1 1.4

5 Overweight was included in automatic data analysis since recently.

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54-59 23 63.9 13 36.1 36 9.6 1.8

Total 178 47.5 197 52.5 375 100.0 0.9

The following tables present the undernutrition rates as follows:

Sex disaggregated weight-for-height z-scores (and/or oedema) and by sex (Table 6) Rates of oedema (Table 7) Sex disaggregated rates of MUAC cut-offs (Table 8) Sex disaggregated weight-for-age z-scores (Table 9) Sex disaggregated height-for-age z-scores (Table 10)

Table 5: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex

All n = 367

Boys n = 174

Girls n = 193

Prevalence of global malnutrition (<-2 z-score and/or oedema)

(44) 12.0 % (9.0 - 15.7 95%

C.I.)

(21) 12.1 % (8.1 - 17.6 95%

C.I.)

(23) 11.9 % (7.9 - 17.6 95%

C.I.)

Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)

(37) 10.1 % (7.3 - 13.7 95%

C.I.)

(18) 10.3 % (6.5 - 16.0 95%

C.I.)

(19) 9.8 % (6.4 - 14.9 95%

C.I.)

Prevalence of severe malnutrition (<-3 z-score and/or oedema)

(7) 1.9 % (0.9 - 4.2 95%

C.I.)

(3) 1.7 % (0.6 - 5.0 95%

C.I.)

(4) 2.1 % (0.8 - 5.3 95%

C.I.)

Table 6: Distribution of acute malnutrition and oedema based on weight-for-height z-scores

<-3 z-score >=-3 z-score

Oedema present Marasmic kwashiorkor No. 0

(0.0 %)

Kwashiorkor No. 0

(0.0 %)

Oedema absent Marasmic No. 14 (3.7 %)

Not severely malnourished No. 361 (96.3 %)

Table 7: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex

All

n = 370 Boys

n = 177 Girls

n = 193

Prevalence of global malnutrition (< 125 mm and/or oedema)

(55) 14.9 % (9.8 - 22.0 95%

C.I.)

(14) 7.9 % (4.1 - 14.8 95%

C.I.)

(41) 21.2 % (14.6 - 29.8 95%

C.I.)

Prevalence of moderate malnutrition (< 125 mm and >= 115 mm, no oedema)

(46) 12.4 % (7.8 - 19.1 95%

C.I.)

(11) 6.2 % (3.0 - 12.4 95%

C.I.)

(35) 18.1 % (11.8 - 26.8 95%

C.I.)

Prevalence of severe malnutrition (< 115 mm and/or oedema)

(9) 2.4 % (1.1 - 5.5 95%

C.I.)

(3) 1.7 % (0.5 - 5.3 95%

C.I.)

(6) 3.1 % (1.2 - 7.7 95%

C.I.)

Table 8: Prevalence of underweight based on weight-for-age z-scores and by sex

All n = 374

Boys n = 177

Girls n = 197

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Prevalence of underweight (<-2 z-score)

(122) 32.6 % (26.5 - 39.4 95%

C.I.)

(60) 33.9 % (25.7 - 43.2 95%

C.I.)

(62) 31.5 % (24.4 - 39.5 95%

C.I.)

Prevalence of moderate underweight (<-2 z-score and >=-3 z-score)

(76) 20.3 % (16.2 - 25.2 95%

C.I.)

(37) 20.9 % (14.6 - 29.0 95%

C.I.)

(39) 19.8 % (14.3 - 26.7 95%

C.I.)

Prevalence of severe underweight (<-3 z-score)

(46) 12.3 % (8.0 - 18.5 95%

C.I.)

(23) 13.0 % (7.6 - 21.3 95%

C.I.)

(23) 11.7 % (7.3 - 18.2 95%

C.I.)

Table 9: Prevalence of stunting based on height-for-age z-scores and by sex

All n = 364

Boys n = 173

Girls n = 191

Prevalence of stunting (<-2 z-score)

(186) 51.1 % (44.9 - 57.3 95%

C.I.)

(95) 54.9 % (46.6 - 63.0 95%

C.I.)

(91) 47.6 % (39.0 - 56.4 95%

C.I.)

Prevalence of moderate stunting (<-2 z-score and >=-3 z-score)

(104) 28.6 % (24.2 - 33.4 95%

C.I.)

(47) 27.2 % (21.3 - 34.0 95%

C.I.)

(57) 29.8 % (23.3 - 37.3 95%

C.I.)

Prevalence of severe stunting (<-3 z-score)

(82) 22.5 % (17.3 - 28.7 95%

C.I.)

(48) 27.7 % (20.4 - 36.5 95%

C.I.)

(34) 17.8 % (12.5 - 24.8 95%

C.I.)

The summary of the Mean Z-scores with their Standard Deviations, the design effects and number of the out of range data per index is the table 11 below. Table 10: Mean z-scores, design effect and excluded subjects

Indicator n Mean z-scores ± SD

Design Effect (z-score < -2)

z-scores not available*

z-scores out of range

Weight-for-Height 367 -0.67±1.09 1.00 0 8

Weight-for-Age 374 -1.61±1.05 1.67 0 1

Height-for-Age 364 -2.02±1.32 1.31 0 11

Child Health and immunization

Retrospective morbidity data was collected among 407 children 0 -59 months (two weeks recalls) to assess the incidence of main diseases and child immunization status. Analysis of data and findings is well illustrated in table 12 and 13.

Table 11: Under-five morbidity, two week recall, n=407

Parameter Frequency Results

Diarrhea 192 47,2%

Acute Respiratory infection 245 60,2%

Table 12: Measles immunization status, children 9-59 mounts, n=355


Yes 63 17,7%

Yes, Recall 124 34,9%

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No 145 40,8%

Do not know 23 6,5%

Maternal Nutritional status

Dara are presented in table 13 and table 14 below.

Table 13: Physiological status of women of reproductive age (15-49 years), n=249


Pregnant 46 18.5%

Lactating 128 51.4%

Pregnant & Lactating 12 4.8%

None of both 63 25.3%

Table 14: Maternal nutritional status based on MUAC cut off, n=249

MUAC cut off Frequency Results

MUAC< 230 mm 44 17.7%

MUAC ≥ 230 mm 205 82.3%

Discussion note

Data Quality and reliability of the results

The age and sex ratios were within accepted limits confirming the respect of the sampling method. The digit preferences were classified as excellent for weight and MUAC, and acceptable for the height, confirming good quality of the anthropometric measurements applied by the team. The precision of the result for weight-for-height z-scores are better than planned: 12.0 % (9.0 - 15.7 95% C.I.), refer to table 2. The mean Z-scores per index (refer to

table 10) were within the limits of WHO recommended6 except for stunting, going slightly

beyond the limit of 1.30.

Overall, the results of this rapid assessment are reliable and recommended for emergency programming.

Undernutrition rates

The GAM rates based on weight-for-height <-2 z-scores of 12.0 % (9.0 - 15.7 95% C.I.) and based on MUAC<125 mm of 14.9 % (9.8 - 22.0 95% C.I.) confirmed the possible existence of serious

situation7. Although not significantly, both rates are higher than those found during the SMART survey conducted by ACF in KIS from December 2011, indicated respectively weight-for-height <-2 z-scores of 7.9 % (5.6 - 10.9 95% C.I.) and MUAC<125 mm 10.4 % (7.8 – 13.6 95% C.I.).

Further analysis of the data suggests that these rates do not refer to same children. Children classified as wasted based WHZ are not fully overlapping with those classified wasted based on MUAC. If both criteria are combined, overall rate of children likely to be eligible for SAM and MAM management in KIS rises to 21,9% (95% CI 17,7-26,1). Only SAM combined rates is estimated to be 5,9% (3,5 – 8,2). Combined rates are recommended to be used for caseload estimation if SAM and MAM management is implemented in KIS.

6 http://www.who.int/nutgrowthdb/about/introduction/en/index5.html 7 WHO acute malnutrition classification: < 5 % acceptable, 5-9 % poor, 10-14 % serious , > 15 % critical

http://www.who.int/nutgrowthdb/about/introduction/en/index5.html

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Chronic under-nutrition that is stunting prevalence was at 51.1% (44.9-57.3 95% CI) indicating one in every second child below five years of age is stunted in KIS. Based on this findings, stunting prevalence in KIS was at very high levels (>40%) based on WHO classification on the gravity of chronic under-nutrition.

The prevalence of underweight was at32.6% (26.5-39.4 95% CI), this form of under-nutrition depicts the burden of acute and chronic under-nutrition among under-fives.

High incidence rates of diarrhoea and ARI at 60.2% and 47.2% reported, is directly linked to current under-nutrition rates in KIS. Continuous monitoring and immediate provision of life-saving services are required in KIS to counteract the high burden of under-nutrition.

Maternal status based on MUAC<230 mm is also low.

Summary of recommendations

Nutrition To organize and provide Outpatient Therapeutic Programmes (OTP) sites through mobile

outreaches to detect, minimize and treat SAM cases in all areas of KIS.

To start Supplementary Feeding Programme(SFP), this will provide targeted solutions for under-fives and maternal nutritionals issues

To provide active screening and strengthen referral systems in community level.

Integration of nutrition, WaSH and FSL programming within the community to address the high under-nutrition.

To increase health education on nutrition and environmental hygiene

Launching food demonstration program in the community to increase knowledge of women on proper using of nutritious local foods.

Training/orientation of mobile clinic staff on how to detect underlying causes in the community and apply for their solution as soon as possible.

Strengthening provision of IFA to all CBA women both in Mobile Clinics (MCs) level by MCs staff and in community by CHWs.

To increase awareness on utilization of nutrition and antenatal care (ANC) services

Child health status Strengthening provision of all types of micronutrients (zinc, vitamin A) both in MCs and

community levels by HFs staff and CHWs.

Need to scale up awareness campaigns for reach out to the intended target population

To increase health education on management of ARI and diarrhoea at Settlements

Provide WaSH community mobilization to increase access safe drinking water and hygiene.

To increase health education on personal and environmental hygiene.

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Annexes

Annex 1: Selected Cluster/Villages for data collection, KIS RNA, January 2016

Geographical unit Population

size Cluster

Parwane Do (3), PD 4, Kabul City 329 1

Shahrake Police (Chamani Babrak), PD 4, Kabul City 4669 2,RC

Sarake Panj Proja Tamani, PD 4, Kabul City 483 3

Puli Campany No 1, PD 5 Kabul City 6118 4,5,6

Puli Campany No 2, PD 5 Kabul City 1414 7

Qalai Wazir, PD 5, Kabul City 497 8

Charahi Qamber (2), PD 5, Kabul City 10192 9,10,11,12,13,14

Sarak Awal Silo, PD 5, Kabul City 63 15

Nasaji Bagrami (1) (Tapa Bagrami), PD 8, Kabul City 1561 16

Kodakistane Bagrami, PD 8, Kabul City 798 17

Qalai Barqi (2) PD 8, Kabul City 336 18

Ghaibi Baba (Tapa Karte Naw), PD 8, Kabul City 1092 19

In front of Hewadwall Blocks, PD 8, Kabul City 1897 RC

Proje Hussain Khil, Bagrami/ PD 12, Kabul 5460 20,21,22

Puli Shina No 1 Bagrami/ PD 12, Kabul 2926 RC

Pule Shina No 2 PD Kabul City 2163 23

Block Hai Qasaba, PD 15, Kabul City 763 24

Ada Mazar, PD 17, Kabul City 280 25

17

Annex 2: Plausibility check for data quality: KIS _ KABUL_ RNA _ 2016_JAN.as Standard/Reference used for z-score calculation: WHO standards 2006

(If it is not mentioned, flagged data is included in the evaluation. Some parts of this plausibility

report are more for advanced users and can be skipped for a standard evaluation)

Overall data quality Criteria Flags* Unit Excel. Good Accept Problematic Score

Flagged data Incl % 0-2.5 >2.5-5.0 >5.0-7.5 >7.5

(% of out of range subjects) 0 5 10 20 0 (2.1 %)

Overall Sex ratio Incl p >0.1 >0.05 >0.001 <=0.001

(Significant chi square) 0 2 4 10 0 (p=0.327)

Age ratio(6-29 vs 30-59) Incl p >0.1 >0.05 >0.001 <=0.001

(Significant chi square) 0 2 4 10 0 (p=0.975)

Dig pref score - weight Incl # 0-7 8-12 13-20 > 20

0 2 4 10 0 (6)

Dig pref score - height Incl # 0-7 8-12 13-20 > 20

0 2 4 10 4 (18)

Dig pref score - MUAC Incl # 0-7 8-12 13-20 > 20

0 2 4 10 0 (7)

Standard Dev WHZ Excl SD <1.1 <1.15 <1.20 >=1.20

. and and and or

. Excl SD >0.9 >0.85 >0.80 <=0.80

0 5 10 20 0 (1.09)

Skewness WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6

0 1 3 5 1 (-0.21)

Kurtosis WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6

0 1 3 5 1 (-0.36)

Poisson dist WHZ-2 Excl p >0.05 >0.01 >0.001 <=0.001

0 1 3 5 0 (p=0.992)

OVERALL SCORE WHZ = 0-9 10-14 15-24 >25 6 %

The overall score of this survey is 6 %, this is excellent.

There were no duplicate entries detected.

Percentage of children with no exact birthday: 79 %

Anthropometric Indices likely to be in error (-3 to 3 for WHZ, -3 to 3 for HAZ, -3 to 3 for

WAZ, from observed mean - chosen in Options panel - these values will be flagged and

should be excluded from analysis for a nutrition survey in emergencies. For other surveys

this might not be the best procedure e.g. when the percentage of overweight children has to

be calculated): Line=159/ID=159: WHZ (-5.303), WAZ (-5.748), Weight may be incorrect

Line=211/ID=211: HAZ (1.367), Height may be incorrect

Line=214/ID=214: HAZ (1.964), Age may be incorrect


Line=286/ID=286: WHZ (-3.777), Height may be incorrect


Line=306/ID=306: HAZ (-5.658), Age may be incorrect


Line=315/ID=315: WHZ (2.301), Height may be incorrect

18






Line=393/ID=393: WHZ (-4.050), Weight may be incorrect





Percentage of values flagged with SMART flags:WHZ: 2.1 %, HAZ: 2.9 %, WAZ: 0.3 %

Age distribution: Month 6 : #####

Month 7 : #######

Month 8 : ########

Month 9 : ####

Month 10 : #########

Month 11 : ####

Month 12 : #######

Month 13 : ###

Month 14 : #######

Month 15 : ######

Month 16 : #####

Month 17 : ##########

Month 18 : ###########################

Month 19 : ###

Month 20 : ######

Month 21 : #####

Month 22 : ##########

Month 23 : ##

Month 24 : #########################

Month 25 : ######

Month 26 : ####

Month 27 : ##

Month 28 : ###

Month 29 : ##

Month 30 : ######################

Month 31 : ####

Month 32 : #######

Month 33 : ######

Month 34 : ######

Month 35 : #####

Month 36 : #############################

Month 37 : ######

Month 38 : ######

Month 39 : ##

Month 40 : ###

Month 41 : ####

Month 42 : ########

Month 43 : #####

19

Month 44 : ###

Month 45 : #

Month 46 : ####

Month 47 : #####

Month 48 : ##############################

Month 49 : ####

Month 50 : #####

Month 51 : #

Month 52 :

Month 53 : ##

Month 54 : ########

Month 55 : #

Month 56 : #######

Month 57 : #

Month 58 : ###########

Month 59 : #########

Age ratio of 6-29 months to 30-59 months: 0.85 (The value should be around 0.85).:

p-value = 0.975 (as expected)

Statistical evaluation of sex and age ratios (using Chi squared statistic): Age cat. mo. boys girls total ratio boys/girls

-------------------------------------------------------------------------------------

6 to 17 12 28/41.3 (0.7) 49/45.7 (1.1) 77/87.0 (0.9) 0.57

18 to 29 12 42/40.3 (1.0) 53/44.6 (1.2) 95/84.8 (1.1) 0.79

30 to 41 12 45/39.0 (1.2) 54/43.2 (1.3) 99/82.2 (1.2) 0.83

42 to 53 12 40/38.4 (1.0) 28/42.5 (0.7) 68/80.9 (0.8) 1.43

54 to 59 6 23/19.0 (1.2) 13/21.0 (0.6) 36/40.0 (0.9) 1.77

-------------------------------------------------------------------------------------

6 to 59 54 178/187.5 (0.9) 197/187.5 (1.1) 0.90

The data are expressed as observed number/expected number (ratio of obs/expect)

Overall sex ratio: p-value = 0.327 (boys and girls equally represented)

Overall age distribution: p-value = 0.083 (as expected)

Overall age distribution for boys: p-value = 0.186 (as expected)

Overall age distribution for girls: p-value = 0.014 (significant difference)

Overall sex/age distribution: p-value = 0.000 (significant difference)

Digit preference Weight: Digit .0 : ########################################

Digit .1 : ###############################

Digit .2 : ###########################################

Digit .3 : ##################################

Digit .4 : ##########################

Digit .5 : ##################################

Digit .6 : #############################################

Digit .7 : ################################

Digit .8 : ###########################################

Digit .9 : ###############################################

Digit preference score: 6 (0-7 excellent, 8-12 good, 13-20 acceptable and > 20 problematic)

p-value for chi2: 0.225

0Digit preference Height: Digit .0 : ###################################

20

Digit .1 : #####################

Digit .2 : #########################

Digit .3 : #######################

Digit .4 : ##############

Digit .5 : ##################################

Digit .6 : ########

Digit .7 : ##########

Digit .8 : ######

Digit .9 : ##########


p-value for chi2: 0.000 (significant difference)

Digit preference MUAC: Digit .0 : #########################################

Digit .1 : ##################################

Digit .2 : ######################################

Digit .3 : #####################################

Digit .4 : ###################################

Digit .5 : ##########################################################

Digit .6 : ##############################

Digit .7 : ###################################

Digit .8 : #################################

Digit .9 : #############################


p-value for chi2: 0.060

Evaluation of Standard deviation, Normal distribution, Skewness and Kurtosis using the 3

exclusion (Flag) procedures . no exclusion exclusion from exclusion from

. reference mean observed mean

. (WHO flags) (SMART flags)

WHZ

Standard Deviation SD: 1.21 1.17 1.09

(The SD should be between 0.8 and 1.2)

Prevalence (< -2)

observed: 13.6% 13.1% 12.0%

calculated with current SD: 14.7% 13.4% 11.2%

calculated with a SD of 1: 10.2% 9.8% 9.1%

HAZ



Prevalence (< -2)

observed: 50.7% 50.5% 51.1%



WAZ



Prevalence (< -2)

observed: 32.8% 32.8% 32.6%



Results for Shapiro-Wilk test for normally (Gaussian) distributed data:

WHZ p= 0.000 p= 0.012 p= 0.056

HAZ p= 0.773 p= 0.394 p= 0.011

WAZ p= 0.000 p= 0.000 p= 0.000

(If p < 0.05 then the data are not normally distributed. If p > 0.05 you can consider the data

21

normally distributed)

Skewness

WHZ -0.58 -0.39 -0.21

HAZ 0.00 0.07 -0.07

WAZ -0.52 -0.52 -0.42

If the value is:

-below minus 0.4 there is a relative excess of wasted/stunted/underweight subjects in the sample

-between minus 0.4 and minus 0.2, there may be a relative excess of wasted/stunted/underweight

subjects in the sample.

-between minus 0.2 and plus 0.2, the distribution can be considered as symmetrical.

-between 0.2 and 0.4, there may be an excess of obese/tall/overweight subjects in the sample.

-above 0.4, there is an excess of obese/tall/overweight subjects in the sample

Kurtosis

WHZ 0.80 0.19 -0.36

HAZ -0.08 -0.22 -0.57

WAZ 0.03 0.03 -0.35

Kurtosis characterizes the relative size of the body versus the tails of the distribution. Positive

kurtosis indicates relatively large tails and small body. Negative kurtosis indicates relatively

large body and small tails.

If the absolute value is:

-above 0.4 it indicates a problem. There might have been a problem with data collection or

sampling.

-between 0.2 and 0.4, the data may be affected with a problem.

-less than an absolute value of 0.2 the distribution can be considered as normal.

Test if cases are randomly distributed or aggregated over the clusters by calculation of the

Index of Dispersion (ID) and comparison with the Poisson distribution for: WHZ < -2: ID=0.42 (p=0.992)

WHZ < -3: ID=1.03 (p=0.426)

GAM: ID=0.42 (p=0.992)

SAM: ID=1.03 (p=0.426)

HAZ < -2: ID=1.38 (p=0.109)

HAZ < -3: ID=1.42 (p=0.090)

WAZ < -2: ID=1.02 (p=0.436)

WAZ < -3: ID=1.55 (p=0.049)

Subjects with SMART flags are excluded from this analysis.

The Index of Dispersion (ID) indicates the degree to which the cases are aggregated into certain

clusters (the degree to which there are "pockets"). If the ID is less than 1 and p > 0.95 it indicates

that the cases are UNIFORMLY distributed among the clusters. If the p value is between 0.05 and

0.95 the cases appear to be randomly distributed among the clusters, if ID is higher than 1 and p is

less than 0.05 the cases are aggregated into certain cluster (there appear to be pockets of cases). If

this is the case for Oedema but not for WHZ then aggregation of GAM and SAM cases is likely

due to inclusion of oedematous cases in GAM and SAM estimates.

Are the data of the same quality at the beginning and the end of the clusters? Evaluation of the SD for WHZ depending upon the order the cases are measured within each

cluster (if one cluster per day is measured then this will be related to the time of the day the

measurement is made). Time SD for WHZ

point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 1.37 (n=23, f=1) ########################

02: 1.65 (n=22, f=2) ####################################

03: 1.43 (n=22, f=1) ##########################

04: 1.19 (n=21, f=0) ################

05: 1.51 (n=22, f=2) ##############################

06: 1.62 (n=22, f=1) ##################################

07: 1.14 (n=21, f=0) ##############

08: 0.96 (n=17, f=0) #######

09: 0.96 (n=20, f=0) #######

10: 0.90 (n=19, f=0) ####

11: 1.00 (n=18, f=0) #########

12: 0.77 (n=19, f=0)

22

13: 1.47 (n=18, f=1) ############################

14: 1.00 (n=15, f=0) ########

15: 0.99 (n=16, f=0) ########

16: 0.89 (n=09, f=0) OOOO

17: 1.16 (n=11, f=0) ###############

18: 0.92 (n=09, f=0) OOOOO

19: 1.07 (n=09, f=0) OOOOOOOOOOO

20: 1.21 (n=07, f=0) OOOOOOOOOOOOOOOOO

21: 1.25 (n=07, f=0) OOOOOOOOOOOOOOOOOOO

22: 0.61 (n=07, f=0)

23: 0.87 (n=05, f=0) OOO

24: 0.25 (n=03, f=0)

25: 0.49 (n=03, f=0)

26: 1.74 (n=02, f=0) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

27: 1.46 (n=02, f=0) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

(when n is much less than the average number of subjects per cluster different symbols are used: 0

for n < 80% and ~ for n < 40%; The numbers marked "f" are the numbers of SMART flags found in the

different time points)

Analysis by Team Team 1 2 3 4 5 6 7 8 n = 78 53 30 33 44 45 49 43

Percentage of values flagged with SMART flags: WHZ: 0.0 0.0 3.3 3.0 9.1 2.2 0.0 0.0

HAZ: 1.3 7.5 6.7 0.0 2.3 2.2 2.0 2.3

WAZ: 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Age ratio of 6-29 months to 30-59 months: 0.86 1.04 1.00 1.36 0.52 0.61 1.04 0.72

Sex ratio (male/female): 1.00 0.89 0.58 0.94 1.00 0.55 0.81 1.69

Digit preference Weight (%): .0 : 10 13 7 15 9 16 4 12

.1 : 8 6 17 6 2 16 8 7

.2 : 10 9 20 6 11 11 10 16

.3 : 10 4 3 0 20 11 10 9

.4 : 5 8 10 3 5 13 4 9

.5 : 10 9 7 6 5 9 18 5

.6 : 12 13 3 18 14 9 14 12

.7 : 8 11 10 15 7 4 8 7

.8 : 8 19 7 15 14 2 18 9

.9 : 19 8 17 15 14 9 4 14

DPS: 12 14 19 20 18 14 17 11

Digit preference score (0-7 excellent, 8-12 good, 13-20 acceptable and > 20 problematic)

Digit preference Height (%): .0 : 18 21 43 18 34 11 4 9

.1 : 5 13 3 21 11 13 14 12

.2 : 18 21 17 9 5 13 8 12

.3 : 13 15 7 9 11 20 8 12

.4 : 9 2 17 9 5 2 8 12

.5 : 26 15 7 18 16 20 18 19

.6 : 4 4 3 0 0 4 10 9

.7 : 1 2 3 3 7 13 8 7

.8 : 3 0 0 6 7 0 10 2

.9 : 4 8 0 6 5 2 10 7

DPS: 26 25 42 22 30 23 12 13


23

Digit preference MUAC (%): .0 : 10 0 7 15 19 24 2 14

.1 : 9 18 17 9 7 2 6 7

.2 : 14 12 3 9 9 0 15 14

.3 : 6 14 20 3 12 9 4 17

.4 : 9 12 10 0 12 13 10 7

.5 : 22 16 17 30 19 11 6 5

.6 : 4 8 7 6 5 13 19 5

.7 : 9 4 3 6 7 18 19 7

.8 : 12 6 13 12 0 2 8 19

.9 : 5 12 3 9 12 7 10 5

DPS: 16 17 20 26 18 24 18 17


Standard deviation of WHZ: SD 1.13 0.96 1.42 1.24 1.50 1.15 1.01 1.32

Prevalence (< -2) observed:

% 11.5 26.7 27.3 18.2 8.9 6.1 11.6

Prevalence (< -2) calculated with current SD:

% 9.5 29.4 18.9 24.8 11.3 7.9 17.9

Prevalence (< -2) calculated with a SD of 1:

% 6.8 22.1 13.7 15.4 8.2 7.6 11.3

Standard deviation of HAZ: SD 1.23 1.74 1.80 1.36 1.32 1.37 1.30 1.41

observed:

% 50.0 54.7 50.0 51.5 50.0 31.1 57.1 60.5

calculated with current SD:

% 46.7 51.1 43.9 47.6 50.9 34.8 62.3 61.2

calculated with a SD of 1:

% 45.9 51.9 39.1 46.7 51.2 29.6 65.8 65.6

Statistical evaluation of sex and age ratios (using Chi squared statistic) for:

Team 1: Age cat. mo. boys girls total ratio boys/girls

-------------------------------------------------------------------------------------

6 to 17 12 8/9.0 (0.9) 9/9.0 (1.0) 17/18.1 (0.9) 0.89

18 to 29 12 8/8.8 (0.9) 11/8.8 (1.2) 19/17.6 (1.1) 0.73

30 to 41 12 7/8.6 (0.8) 10/8.6 (1.2) 17/17.1 (1.0) 0.70

42 to 53 12 8/8.4 (1.0) 9/8.4 (1.1) 17/16.8 (1.0) 0.89

54 to 59 6 8/4.2 (1.9) 0/4.2 (0.0) 8/8.3 (1.0)

-------------------------------------------------------------------------------------

6 to 59 54 39/39.0 (1.0) 39/39.0 (1.0) 1.00





Overall age distribution for girls: p-value = 0.289 (as expected)

Overall sex/age distribution: p-value = 0.060 (as expected)


-------------------------------------------------------------------------------------

6 to 17 12 3/5.8 (0.5) 8/6.5 (1.2) 11/12.3 (0.9) 0.38

18 to 29 12 8/5.7 (1.4) 8/6.3 (1.3) 16/12.0 (1.3) 1.00

30 to 41 12 7/5.5 (1.3) 7/6.1 (1.1) 14/11.6 (1.2) 1.00

42 to 53 12 3/5.4 (0.6) 3/6.0 (0.5) 6/11.4 (0.5) 1.00

24

54 to 59 6 4/2.7 (1.5) 2/3.0 (0.7) 6/5.7 (1.1) 2.00

-------------------------------------------------------------------------------------

6 to 59 54 25/26.5 (0.9) 28/26.5 (1.1) 0.89








-------------------------------------------------------------------------------------

6 to 17 12 0/2.6 (0.0) 6/4.4 (1.4) 6/7.0 (0.9) 0.00

18 to 29 12 5/2.5 (2.0) 4/4.3 (0.9) 9/6.8 (1.3) 1.25

30 to 41 12 1/2.4 (0.4) 6/4.2 (1.4) 7/6.6 (1.1) 0.17

42 to 53 12 5/2.4 (2.1) 1/4.1 (0.2) 6/6.5 (0.9) 5.00

54 to 59 6 0/1.2 (0.0) 2/2.0 (1.0) 2/3.2 (0.6) 0.00

-------------------------------------------------------------------------------------

6 to 59 54 11/15.0 (0.7) 19/15.0 (1.3) 0.58




Overall age distribution for boys: p-value = 0.041 (significant difference)




-------------------------------------------------------------------------------------

6 to 17 12 4/3.7 (1.1) 2/3.9 (0.5) 6/7.7 (0.8) 2.00

18 to 29 12 4/3.6 (1.1) 9/3.8 (2.3) 13/7.5 (1.7) 0.44

30 to 41 12 5/3.5 (1.4) 4/3.7 (1.1) 9/7.2 (1.2) 1.25

42 to 53 12 3/3.5 (0.9) 2/3.7 (0.5) 5/7.1 (0.7) 1.50

54 to 59 6 0/1.7 (0.0) 0/1.8 (0.0) 0/3.5 (0.0)

-------------------------------------------------------------------------------------

6 to 59 54 16/16.5 (1.0) 17/16.5 (1.0) 0.94





Overall age distribution for girls: p-value = 0.033 (significant difference)



-------------------------------------------------------------------------------------

6 to 17 12 3/5.1 (0.6) 4/5.1 (0.8) 7/10.2 (0.7) 0.75

18 to 29 12 4/5.0 (0.8) 4/5.0 (0.8) 8/10.0 (0.8) 1.00

30 to 41 12 8/4.8 (1.7) 7/4.8 (1.5) 15/9.6 (1.6) 1.14

42 to 53 12 5/4.7 (1.1) 5/4.7 (1.1) 10/9.5 (1.1) 1.00

54 to 59 6 2/2.3 (0.9) 2/2.3 (0.9) 4/4.7 (0.9) 1.00

-------------------------------------------------------------------------------------

6 to 59 54 22/22.0 (1.0) 22/22.0 (1.0) 1.00




25





-------------------------------------------------------------------------------------

6 to 17 12 1/3.7 (0.3) 6/6.7 (0.9) 7/10.4 (0.7) 0.17

18 to 29 12 1/3.6 (0.3) 9/6.6 (1.4) 10/10.2 (1.0) 0.11

30 to 41 12 7/3.5 (2.0) 7/6.4 (1.1) 14/9.9 (1.4) 1.00

42 to 53 12 6/3.5 (1.7) 5/6.3 (0.8) 11/9.7 (1.1) 1.20

54 to 59 6 1/1.7 (0.6) 2/3.1 (0.6) 3/4.8 (0.6) 0.50

-------------------------------------------------------------------------------------

6 to 59 54 16/22.5 (0.7) 29/22.5 (1.3) 0.55




Overall age distribution for boys: p-value = 0.049 (significant difference)




-------------------------------------------------------------------------------------

6 to 17 12 3/5.1 (0.6) 9/6.3 (1.4) 12/11.4 (1.1) 0.33

18 to 29 12 6/5.0 (1.2) 7/6.1 (1.1) 13/11.1 (1.2) 0.86

30 to 41 12 4/4.8 (0.8) 9/5.9 (1.5) 13/10.7 (1.2) 0.44

42 to 53 12 6/4.7 (1.3) 0/5.8 (0.0) 6/10.6 (0.6)

54 to 59 6 3/2.3 (1.3) 2/2.9 (0.7) 5/5.2 (1.0) 1.50

-------------------------------------------------------------------------------------

6 to 59 54 22/24.5 (0.9) 27/24.5 (1.1) 0.81








-------------------------------------------------------------------------------------

6 to 17 12 6/6.3 (1.0) 5/3.7 (1.3) 11/10.0 (1.1) 1.20

18 to 29 12 6/6.1 (1.0) 1/3.6 (0.3) 7/9.7 (0.7) 6.00

30 to 41 12 6/5.9 (1.0) 4/3.5 (1.1) 10/9.4 (1.1) 1.50

42 to 53 12 4/5.8 (0.7) 3/3.5 (0.9) 7/9.3 (0.8) 1.33

54 to 59 6 5/2.9 (1.7) 3/1.7 (1.8) 8/4.6 (1.7) 1.67

-------------------------------------------------------------------------------------

6 to 59 54 27/21.5 (1.3) 16/21.5 (0.7) 1.69







26

Evaluation of the SD for WHZ depending upon the order the cases are measured within each

cluster (if one cluster per day is measured then this will be related to the time of the day the

measurement is made).

Team: 1 Time SD for WHZ

point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 1.00 (n=04, f=0) #########

02: 1.79 (n=04, f=0) ##########################################

03: 1.11 (n=04, f=0) #############

04: 0.35 (n=04, f=0)

05: 1.57 (n=04, f=0) #################################

06: 0.86 (n=03, f=0) ###

07: 1.01 (n=04, f=0) #########

08: 0.84 (n=02, f=0) OO

09: 1.08 (n=03, f=0) ############

10: 1.05 (n=04, f=0) ###########

11: 0.45 (n=02, f=0)

12: 0.83 (n=04, f=0) #

13: 0.63 (n=04, f=0)

14: 0.46 (n=03, f=0)

15: 1.74 (n=04, f=0) #######################################

16: 1.04 (n=03, f=0) ##########

17: 1.66 (n=04, f=0) ####################################

18: 1.31 (n=04, f=0) ######################

19: 1.96 (n=03, f=0) #################################################

20: 1.62 (n=03, f=0) ###################################

21: 0.39 (n=02, f=0)

22: 0.20 (n=02, f=0)

23: 0.56 (n=02, f=0)





point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 0.94 (n=03, f=0) ######

02: 0.43 (n=03, f=0)

03: 1.01 (n=03, f=0) #########

04: 1.39 (n=03, f=0) #########################

05: 1.00 (n=03, f=0) ########

06: 0.58 (n=03, f=0)

07: 0.57 (n=03, f=0)

08: 0.75 (n=03, f=0)

09: 0.54 (n=03, f=0)

10: 0.38 (n=03, f=0)

12: 0.63 (n=03, f=0)

13: 1.47 (n=03, f=0) ############################

14: 1.47 (n=03, f=0) ############################

15: 0.73 (n=03, f=0)

17: 0.36 (n=02, f=0)

18: 0.32 (n=02, f=0)

19: 0.17 (n=02, f=0)





point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 2.46 (n=03, f=0) ################################################################

02: 1.80 (n=02, f=0) ##########################################

03: 0.77 (n=03, f=0)

04: 0.83 (n=03, f=0) #

05: 0.92 (n=03, f=0) #####

06: 1.38 (n=03, f=1) #########################

07: 0.07 (n=02, f=0)

08: 2.17 (n=02, f=0) #########################################################

09: 0.05 (n=02, f=0)

27

10: 0.09 (n=02, f=0)

11: 2.53 (n=02, f=0) ################################################################

12: 1.49 (n=02, f=0) #############################





point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 1.42 (n=03, f=0) ##########################

02: 1.83 (n=03, f=0) ###########################################

03: 1.17 (n=03, f=0) ###############

04: 1.10 (n=02, f=0) OOOOOOOOOOOO

05: 2.03 (n=03, f=0) ####################################################

06: 1.05 (n=03, f=0) ###########

07: 1.55 (n=03, f=0) ################################

08: 1.29 (n=03, f=0) #####################

09: 0.06 (n=02, f=0)

10: 1.25 (n=03, f=0) ###################

11: 0.60 (n=03, f=0)





point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 2.80 (n=02, f=1) ################################################################

02: 4.00 (n=02, f=1) ################################################################

04: 1.29 (n=02, f=0) #####################

05: 2.08 (n=02, f=0) ######################################################

06: 1.05 (n=02, f=0) ##########

07: 1.11 (n=02, f=0) #############

09: 0.13 (n=02, f=0)

10: 1.21 (n=02, f=0) #################

11: 1.59 (n=02, f=0) #################################

12: 1.11 (n=02, f=0) #############

13: 2.83 (n=02, f=1) ################################################################

14: 1.22 (n=02, f=0) ##################

15: 1.16 (n=02, f=0) ###############





point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 0.31 (n=02, f=0)

02: 0.14 (n=02, f=0)

03: 1.42 (n=02, f=0) ##########################

05: 1.01 (n=02, f=0) #########

06: 0.79 (n=02, f=0)

07: 0.91 (n=02, f=0) ####

09: 0.08 (n=02, f=0)

11: 1.12 (n=02, f=0) ##############

12: 0.91 (n=02, f=0) #####

13: 2.20 (n=02, f=0) ###########################################################

14: 0.66 (n=02, f=0)

15: 0.08 (n=02, f=0)

16: 0.82 (n=02, f=0) #

17: 0.86 (n=02, f=0) ###

18: 0.20 (n=02, f=0)

19: 0.70 (n=02, f=0)

21: 1.00 (n=02, f=0) ########

22: 0.00 (n=02, f=0)




Team: 7

28

Time SD for WHZ

point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 0.53 (n=03, f=0)

02: 1.18 (n=03, f=0) ################

03: 0.22 (n=03, f=0)

04: 1.45 (n=03, f=0) ###########################

05: 0.76 (n=03, f=0)

06: 1.72 (n=03, f=0) #######################################

07: 1.19 (n=02, f=0) ################

08: 0.69 (n=02, f=0)

09: 0.80 (n=03, f=0)

10: 0.97 (n=03, f=0) #######

11: 0.25 (n=03, f=0)

12: 0.40 (n=03, f=0)

13: 0.81 (n=02, f=0) #

14: 0.54 (n=02, f=0)

15: 0.22 (n=02, f=0)

16: 0.07 (n=02, f=0)





point 0.8 0.9 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2 2.3

01: 0.47 (n=03, f=0)

02: 0.72 (n=03, f=0)

03: 2.85 (n=03, f=1) ################################################################

04: 2.05 (n=03, f=0) #####################################################

05: 0.59 (n=02, f=0)

06: 2.10 (n=03, f=0) #######################################################

07: 2.04 (n=03, f=0) ####################################################

08: 0.50 (n=03, f=0)

09: 0.83 (n=03, f=0) #

11: 0.69 (n=03, f=0)

12: 0.41 (n=02, f=0)

13: 0.45 (n=03, f=0)

14: 1.62 (n=03, f=0) ###################################

15: 0.79 (n=03, f=0)




(for better comparison it can be helpful to copy/paste part of this report into Excel)

29

Annex 3: Kabul Informal Settlements (KIS) map

30

Annex 4: RNA questionnaire

/دکلستر نمیرنمبر کلستر د سروی تاریخ/تاریخ سروی /ټیم نمبرنمبر تیم نام قریه دکلی نوم / د کور/ نمبر خانه

نمبر

دماشوم

نمبر/نمبر

طفل

جنس

جنس/F/M

د ماشوم

دپیدایش

ت نیټه /دقیق

تاریخ

تولد

عمرپه

میاشت/

به عمر

ماه

وزن په کیلو

به وزن ګرام /

کیلوګرام XX.X

قد په سانتی

متر/

سانتی بهقد

متر XXX.X

پړسوب/

پندیده گی

= بلی / هو 1

= نه / نخیر 2

موک په ملی

به موک متر/

ملی متر XXX

ایا طفل شما در دو هفته

/ایا ؟ګذتشه اسهال شده بود

ستاسی ماشوم په تیرو

دوه اونیو کی ناروغ شوی

دی ؟

هو = بلی / 1

= نه / نخیر2

ایا طفل شما در دوه هفته

ګذشته سرفه یا مشکالت

/ ایا ستاسی ؟تنفسی داشت

ماشوم په تیرو دوه اونیو

کی ناروغ شوی دی ؟

= بلی / هو 1

= نه / نخیر2

ایا ستاسی ماشوم د شری

واکسین اخیستی دی ؟/ایا طفل شما واکسین

؟سرخګان ګرفته است

/ هو = بلی کارد دارد1

کارت لری.

= بلی کارد ندارد / هو 2

کارت لری.

= نخیر / نه .3

= نه پوهیژم / نمی فهمم . 4

کالو پوری وی 94تر 51دهغه زنانو لپاره چی عمرونه یی د / سال باشد 94الی 51برای خانم های که سن شان از

نمبر تیم/تیم نمبر : :/کلستر نمبر نمبر کلستر ټه :/ نی تاریخ :نام قریه / د کلی نوم

شماره مسلسل / پرله پسی

نمره

نمبر خانواده / د کورنی

نمبر

ت حال/ فزیالوژیک حالت فزیالوژیک

حامله =حامله/1

شیدی ورکونکی شیر دهی / = 2

حامله او شیدی ورکونکی / شیرده و حامله = 3

یو هم نه = هیچ کدام / 4

عمر به / عمر په کال

سال

/ د اندازه بازو به ملی متر

مټ اندازه به ملی متر

پړسوب / پندیدګی

= بلی / هو 1

= نخیر / نه 2

31

Annex 5: RNA tally sheet

15 – 49 years women سال باشد 94الی 11ی که سن شان از برای خانم ها

Locationموقعت: Date: تاریخ (Cluster Noنمبر کلستر :) Team No نمبر تیم:

Mother No

شماره مسلسل

HH No

نمبر خانواده

Physiological status: حالت

فزیالوژیک

1 = Pregnant/حامله

2 = Lactating / شیر دهی

3 = Pregnant & Lactating شیرده

و حامله /

4 =None of both هیچ کدام /

Age عمر به

سال

/(years)

MUAC

(mm) ###

اندازه بازو به

ملی متر

Oedema

=1 Y بلی

=2 N نخیر

rapid nutrition assessment (rna) report · 13th to 19th january, 2016 ... acf is a...

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